title: Multicenter evaluation of the Verigene Clostridium difficile nucleic acid assay.
abstract: The Verigene Clostridium difficile Nucleic Acid test (Verigene CDF test) (Nanosphere, Northbrook, IL) is a multiplex qualitative PCR assay that utilizes a nanoparticle-based array hybridization method to detect C. difficile tcdA and tcdB in fecal specimens. In addition, the assay detects binary toxin gene sequences and the single base pair deletion at nucleotide 117 (Δ 117) in tcdC to provide a presumptive identification of the epidemic strain 027/NAP1/BI (referred to here as ribotype 027). This study compared the Verigene CDF test with anaerobic direct and enriched toxigenic culture on stool specimens from symptomatic patients among five geographically diverse laboratories within the United States. The Verigene CDF test was performed according to the manufacturer's instructions, and the reference methods performed by a central laboratory included direct culture onto cycloserine cefoxitin fructose agar (CCFA) and enriched culture using cycloserine cefoxitin mannitol broth with taurocholate and lysozyme. Recovered isolates were identified as C. difficile using gas liquid chromatography and were tested for toxin using a cell culture cytotoxicity neutralization assay. Strains belonging to ribotype 027 were determined by PCR ribotyping and bidirectional sequencing for Δ 117 in tcdC. A total of 1,875 specimens were evaluable. Of these, 275 specimens (14.7%) were culture positive by either direct or enriched culture methods. Compared to direct culture alone, the overall sensitivity, specificity, positive predictive value, and negative predictive value for the Verigene CDF test were 98.7%, 87.5%, 42%, and 99.9%, respectively. Compared to combined direct and enriched culture results, the sensitivity, specificity, positive predictive value, and negative predictive values of the Verigene CDF test were 90.9%, 92.5%, 67.6%, and 98.3%, respectively. Of the 250 concordantly culture-positive specimens, 59 (23.6%) were flagged as "hypervirulent"; 53 were confirmed as ribotype 027, and all 59 possessed Δ 117 in tcdC. Time to results was approximately 2.5 h per specimen. The Verigene CDF test is a novel nucleic acid microarray that reliably detects both C. difficile toxins A and B in unformed stool specimens and appears to adequately identify ribotype 027 isolates.
authors.affiliation: Department of Pathology, the Johns Hopkins University School of Medicine.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Blake W
authors.initials: BW
authors.lastname: Buchan
authors.forename: Sokha
authors.initials: S
authors.lastname: Tan
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stamper
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Riebe
authors.forename: Preeti
authors.initials: P
authors.lastname: Pancholi
authors.forename: Cheryl
authors.initials: C
authors.lastname: Kelly
authors.forename: Arundhati
authors.initials: A
authors.lastname: Rao
authors.forename: Robert
authors.initials: R
authors.lastname: Fader
authors.forename: Robert
authors.initials: R
authors.lastname: Cavagnolo
authors.forename: Wendy
authors.initials: W
authors.lastname: Watson
authors.forename: Richard V
authors.initials: RV
authors.lastname: Goering
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Trevino
authors.forename: Alice S
authors.initials: AS
authors.lastname: Weissfeld
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Ledeboer
mesh_terms: D001427:Bacterial Toxins / Q000032:analysis; D001431:Bacteriological Techniques / Q000379:methods*; D018929:Cell Culture Techniques; D002849:Chromatography, Gas; D016360:Clostridioides difficile / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D004751:Enteritis / Q000175:diagnosis* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021521:Ribotyping; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D001427:Bacterial Toxins; D004269:DNA, Bacterial